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woman with herpes/moment of non-protected vaginal sex with hiv+ man
May 30, 2001

Hi, I scoured your the previously posed questions but didn't find a situation like mine. I had sex with a man I've known for 8 years last night. We had sex with a condom for a few minutes and then stopped. A little while later, he slid inside of my vagina for about half a minute. There was lots of lubricant used. A few minutes after that, he came on my lower back by rubbing his penis on my buttocks. After that, he performed (unprotected)oral sex on me. Sorry to get graphic, but I am scared and need to be specific. I have had genital herpes for 10 years and it's also been a long time since I've had a breakout. I am on a preventative treatment of Acyclovir of 200mg a day which has reduced my outbreaks to almost nil. The reason for my panic is that after the sexual contact, I wanted to be "sure" and asked him if he'd been tested because he HAD been inside of me for those brief moments. It was at this time that he informed me that he has been HIV+ for the last 13 years. I am so stunned and scared. Can you please tell me what you think my risk factor is? I have heard of a drug treatment (PEP) that may be taken after known exposure to HIV if taken within 72 hours of the contact. The trials were done in '97. What do you think about that? I don't know how I'm going to get through the next three months worrying and just waiting. Thanks so much for your help!

P.S. This man is begging me not to be scared or worry (the gall) because he says that he is "non-syptomatic" or something. Also that he has lived with women in long-term relationships who were HIV- and not infected them. He says that he never came inside them but was sometimes in there for brief moments. Obviously, I wouldn't stake anything on what this man says anymore, but just wondered if the added info would be relevant. Thanks again.

Response from Mr. Kull

Based upon the description of your sexual encounter with this HIV positive man, the only behavior that constituted a real risk for infection was the time that his penis was inside of your vagina. The fact that the exposure was brief and that he did not ejaculate inside of you is reassuring. However, it is possible that you were exposed to pre-ejaculatory fluid, so there is some risk. It is difficult to measure how much fluid or what duration of sexual activity increases or decreases the odds for infection. See "Risk of Infection" (http://www.thebody.com/Forums/AIDS/SafeSex/Archive/TransmissionSexual/Q16749.qna).

Your partner's viral load could have an impact on the likelihood of transmission. Studies have shown that individuals with a very low or undetectable viral load were less likely to infect their sexual partners. His viral load may be more relevant than whether or not he infected his partners in the past.

A recent study has shown that the odds of infection per episode of unprotected penile-vaginal intercourse are about 1 in 500. This means that one episode of unprotected intercourse with an infected person is not likely to lead to infection, a confirmation of previous studies of per contact risk. Being infected with HSV-2 (the type of herpes that generally causes genital sores) did seem to increase the risk for infection in this particular study. See The Body's coverage of this study at http://thebody.com/confs/retro2001/pavia10.html.

You might be eligible for post-exposure prophylaxsis, depending on the availability in your area and the specific protocol in place. You can contact your private doctor, nearest hospital, or AIDS service organization. For more information about PEP, see my responses to "HELP!" (http://www.thebody.com/Forums/AIDS/SafeSex/Archive/Treatment/Q13389.qna) and "PEP after oral sex" (http://www.thebody.com/Forums/AIDS/SafeSex/Archive/Treatment/Q16861.qna).

Experiences like yours can be troubling. It clearly demonstrates why using condoms regardless of what you think or what your partner says can be important. Your question points out that your partner may be in some denial about the possibility that he could infect others. Like I always say, seek out some psychological support during this potentially stressful period if you can.

RMK



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